Demise of the triple

Triple therapy, the combination of methotrexate (MTX), sulfasalazine (SSZ), and hydroxychloroquine (HCQ), appears to be effective in selective patients with rheumatoid arthritis (RA). Three large, well-designed clinical trials have compared triple therapy to the combination of MTX and a biological TNF inhibitor (TNF-i) with favorable, or at least non-inferior, conclusions with regards to efficacy and safety, and triple therapy was dramatically less costly.